Speroff L, Mishell DR, Jr. The postpartum visit: it's time for a change in order to
optimally initiate contraception. Contraception. Aug 2008;78(2):90-98.
Postpartum Contraception: Best Practices Leah Torres, MD Family Planning Fellow, University of Utah
Disclosures Coming from Utah
Goals To change old, outdated practices for the better To dispel the myths surrounding safe and appropriate postpartum contraception
To provide tools for being the best practitioner you can be!
Your patients and their families will thank you!
The Postpartum Visit: Timing is Everything “Six weeks” is an old tradition No Longer Relevant
A 3-week visit would be more effective in preventing postpartum conception by initiating effective contraception at this time, instead of after the 6-week visit Speroff L, Mishell DR, Jr. The postpartum visit: it's time for a change in order to optimally initiate contraception. Contraception. Aug 2008;78(2):90-98.
Return to Ovulation Non-breastfeeding women
Within 3-5 weeks postpartum: Prolactin levels return to normal GnRH pulsatility returns Mean delay of return to ovulation:
45 days, earliest 25 days Ovulation may occur as early as 3 weeks postpartum Speroff L, Darney P. A Clinical Guide for Contraception. 4th ed; 2005: Ch 10 ref Campbell et al and Gray et al Jackson E, Glasier A. Return of ovulation and menses in postpartum nonlactating women: a systematic review. Obstet. Gynecol. Mar 2011;117(3):657-662
Return to Ovulation Breastfeeding women
Prolactin continues to inhibit GnRH pulsatility Bellagio Consensus: Full Breastfeeding + Amenorrhea = 98% Protection for first 6 months
After 6 months or with menstruation protection declines
Kennedy KI, et al. Contraception. May 1989;39(5):477-496
Return to Sexual Activity We say “not before 6 weeks,” but why? Historically: risks of infection
New parents embarking on new, exciting journey What are women really doing? 100% 80% 60%
